Quality Assurance Management

GISMELL ABUD

White Plains, NY ***** 646-***-**** ***********@*****.***

QUALIFICATIONS

Innovative, diligent and results-driven professional with proven record of success in leading technology initiatives and streamlining existing business operations to gain and ensure profitability. Possess well-developed qualifications acquired from comprehensive in supporting daily and operation functions.

EDUCATION

Berkeley College White Plains, NY

Bachelor of Applied Science in Business Management Information Technology Management

December 2016

Associate of Applied Science in Business Administration Information Systems Management

December 2004

PROFESSIONAL EXPERIENCE

OrthoNet, LLC White Plains, NY

Quality Assurance and Training Manager

September 2003-Present

Collaborated with Project Managers and vendors to develop and implement a medical management software that is currently being utilized within OrthoNet.

Create business goals and objectives to determine system requirements.

Create software and web portal testing requirements, developed and reviewed scripts for positive and negative test scenarios, and conducted baseline testing.

Design test plans and defined cases for functional, integration system and user acceptance testing.

Performed analysis and presented results using SQL, MS Access, Excel and Visual Basic scripts.

Designed OrthoNet’s current monitoring database/program to ensure all key points were captured as well as reported accurately to all Health Plans.

Developed and continue to maintain quality improvement policies and procedures; including but not limited to, training manuals, program description, work plan and program evaluations in accordance with Quality Assurance Standards and HIPAA regulations.

Implemented an umbrella management function that brands, centralizes and standardizes training, job support and quality management across OrthoNet’s call centers located in New York and California.

Coordinate quality improvement initiatives between all internal departments as well as with external partners.

Perform timely research, accurately report and continue to monitor events and complaints that are identified as potential quality of care concerns.

Apply subject matter expertise in every implementation/expansion related to training and quality; collaborate with the Vice President of Operations and the management team to assure standardization, communication, calibration and consistency.

Spearhead analysis, design and develop initiatives related to new-hires, refresher and staff development training needs of Call Center Representatives and Supervisors; recommend appropriate learning and job support solutions.

Render expert oversight regarding client’s complaints and provide accurate resolutions to problems encountered within the Department of Insurance.

Assist OrthoNet’s Regulatory Compliance Officer to ensure HIPAA requirements are met by researching and following within the compliance regulations.

OrthoNet, LLC White Plains, NY

Operations Manager, Provider Services

April 2011-November 2015

Proactively managed 70-75 Call Center Representatives in New York and California who handled an average of 3,300 daily inbound calls.

Supervised eleven major customer contracts; including Aetna, Amerigroup, Anthem, BlueCross BlueShield, Cigna, Empire, GEHA, HealthFirst, Humana, Oxford and United States Family Health Plan.

Skillfully monitored unit productivity to ensure calls are handled within service levels (80-90% of answered calls within a 20-30 seconds average speed of answer).

Eagerly established service development initiatives aligned to department objectives, which included staff recognition programs, quality of service and first call resolution.

Assisted the Human Resources Department with hiring, scheduling, staff development, training and coaching.

TECHNICAL PROFICIENCY/SKILLS

Microsoft Word, Excel, PowerPoint and Access

EzCap/EasyView/SunGard EXP Macess

Encoder Pro/Crystal Reports/ADP Workforce Now

Quality Management Suite (Call Rex)

Cisco Historical Reports/Supervisory Desktop

Fluent in Spanish

Problem Solving/Analytical/Interpersonal Skills

Schedule/Time Management

Systems Analysis, Project Planning and Development

Quality Assurance

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